Clinical depression
Some people still think that
depression is trivial and not a genuine health condition. They're
wrong. Depression is a real illness with real symptoms, and it's not
a sign of weakness or something you can "snap out of" by
"pulling yourself together". The good news is that with the right
treatment and support, most people can make a full recovery.
How to tell if you
have depression
Depression affects people in
different ways and can cause a wide variety of symptoms. They range from lasting feelings of
sadness and hopelessness, to losing interest in the things you used to
enjoy and feeling very tearful. Many people with depression also have
symptoms of anxiety.
There can be physical symptoms
too, such as feeling constantly tired, sleeping
badly, having no appetite or sex drive,
and complaining of various aches and pains. The severity of the symptoms can
vary. At its mildest, you may simply feel persistently low in spirit, while at
its most severe depression can make you feel suicidal and that life
is no longer worth living.
Most people experience feelings of
stress, sadness or anxiety during difficult times. A low mood may
improve after a short time, rather than being a sign of depression.
When to see a doctor
It is important to seek help from your doctor if you think you may be depressed. Many people wait a long time before
seeking help for depression, but it's best not to delay. The sooner you
see a doctor, the sooner you can be on the way to recovery.
Sometimes there is a trigger for
depression. Life-changing events, such as bereavement, losing your job or even
having a baby, can bring it on. People with a family history of
depression are also more likely to experience it themselves. But you can also
become depressed for no obvious reason.
Depression is quite common and
affects about one in 10 of us at some point. It affects men and
women, young and old.
Depression
can also strike children. Studies have shown that about 4% of
children aged five to 16 in the UK are anxious or depressed.
Treatment
Treatment for depression
involves either medication or talking treatments, or usually a combination of
the two. The kind of treatment that your doctor recommends will
be based on the type of depression you have.
Living with depression
Many people with depression
benefit by making lifestyle changes such as getting more
exercise, cutting down on alcohol, stopping smoking and eating more
healthily. Self-help measures such as reading a
self-help book or joining a support group are also worthwhile.
Causes
There is no single cause of
depression. You can develop it for different reasons and it has many
different triggers. For some, an upsetting or
stressful life event – such as bereavement, divorce, illness, redundancy and
job or money worries – can be the cause.
Often, different causes combine to
trigger depression. For example, you may feel low after an illness and
then experience a traumatic event, such as bereavement, which brings
on depression.
People often talk about a
"downward spiral" of events that leads to depression. For
example, if your relationship with your partner breaks down, you're
likely to feel low, so you stop seeing friends and family and you
may start drinking more. All of this can make you feel even
worse and trigger depression.
Some studies have also suggested
you're more likely to get depression as you get older, and
that it's more common if you live in difficult social and economic
circumstances.
Stressful events
Most people take time to
come to terms with stressful events, such as bereavement or a relationship
breakdown. When these stressful events happen, you have a higher risk of
becoming depressed if you stop seeing your friends and family and
you try to deal with your problems on your own.
Illness
You may have a higher risk
of depression if you have a longstanding or
life-threatening illness, such as coronary heart disease or cancer. Head injuries are also an often
under-recognised cause of depression. A severe head injury can trigger mood
swings and emotional problems.
Some people may have an underactive thyroid (hypothyroidism) resulting
from problems with their immune system. In rarer cases a minor head injury can damage the
pituitary gland, a pea-sized gland at the base of your brain that produces
thyroid-stimulating hormones.
This can cause a number of symptoms,
such as extreme tiredness and a loss of interest in sex (loss of libido), which can in turn lead
to depression.
Personality
You may be more vulnerable
to depression if you have certain personality traits, such
as low self-esteem or being overly self-critical. This may be because
of the genes you've inherited from your parents, or because of your early
life experiences.
Family history
If someone else in your family has
suffered from depression in the past, such as a parent or sister or brother,
then it's more likely you will too.
Giving birth
Some women are particularly vulnerable
to depression after pregnancy. The hormonal and physical changes, as well
as added responsibility of a new life, can lead to postnatal depression.
Loneliness
Becoming cut off from your
family and friends can increase your risk of depression.
Alcohol and drugs
Some people try to cope when life is
getting them down by drinking too much alcohol or taking drugs. This can result in a spiral
of depression. Cannabis helps you relax, but there
is evidence that it can bring on depression, especially in teenagers.
And don't be tempted to drown
your sorrows with a drink. Alcohol is categorised as a "strong
depressant" and actually makes depression worse.
Symptoms of clinical depression
The symptoms of depression can
be complex and vary widely between people. But as a general rule, if you
are depressed, you feel sad, hopeless and lose interest in things you
used to enjoy.
The symptoms persist for weeks or
months and are bad enough to interfere with your work, social life and
family life.
There are many other symptoms
of depression and you're unlikely to have every one listed
below.
If you experience some of these
symptoms for most of the day, every day for more than two weeks, you should
seek help from your doctor.
Psychological symptoms include:
- continuous low mood or sadness
- feeling hopeless and helpless
- having low self-esteem
- feeling tearful
- feeling guilt-ridden
- feeling irritable and intolerant of others
- having no motivation or interest in things
- finding it difficult to make decisions
- not getting any enjoyment out of life
- feeling anxious or worried
- having suicidal thoughts or thoughts
of harming yourself.
Physical symptoms include:
- moving or speaking more slowly than usual
- change in appetite or weight (usually decreased, but sometimes
increased)
- constipation
- unexplained aches and pains
- lack of energy or lack of interest in sex (loss of libido)
- changes to your menstrual cycle
- disturbed sleep (for example, finding it hard to fall asleep at
night or waking up very early in the morning).
Social symptoms include:
- not doing well at work
- taking part in fewer social activities and avoiding contact with
friends
- neglecting your hobbies and interests
- having difficulties in your home and family life.
Depression can come on
gradually, so it can be difficult to notice something is wrong. Many
people continue to try to cope with their symptoms without realising they
are ill. It can take a friend or family member to suggest something is wrong.
Doctors describe depression by
how serious it is:
- mild depression has some impact on your daily life
- moderate depression has a significant
impact on your daily life
- severe depression makes it almost
impossible to get through daily life – a few people with
severe depression may have psychotic symptoms.
Grief and depression
It can be hard to distinguish between
grief and depression. They share many of the same characteristics,
but there are important differences between them. Grief is an entirely natural response
to a loss, while depression is an illness.
People who are grieving find their
feelings of loss and sadness come and go, but they're still able to enjoy
things and look forward to the future. In contrast, people who
are depressed have a constant feeling of sadness. They don't enjoy
anything and find it hard to be positive about the future.
Other types of depression
There are different types of
depression, and some conditions where depression may be one of the symptoms.
These include:
- Postnatal depression. Some women develop
depression after having a baby. Postnatal depression is treated in similar
ways to other forms of depression, with talking therapies and
antidepressant medicines.
- Bipolar disorder is also known as
"manic depression". It's where there are spells of
depression and excessively high mood (mania). The depression symptoms
are similar to clinical depression, but the bouts of mania can
include harmful behaviour such as gambling, going on spending sprees and
having unsafe sex.
- Seasonal affective disorder (SAD). Also known as "winter depression", SAD is a type of depression that has a seasonal pattern usually related to winter.
When to seek help
If you experience symptoms of
depression for most of the day, every day for more than two weeks, you should
seek help from your doctor.
Diagnosing clinical depression
If you experience symptoms of
depression for most of the day, every day for more than two weeks, you should
seek help from your doctor. It is especially important to speak
to your doctor if you experience:
- symptoms of depression that are not improving
- your mood affects your work, other interests,
and relationships with your family and friends
- thoughts of suicide or self-harm.
Sometimes, when people are depressed
they find it hard to imagine that treatment can actually help. But
the sooner you seek treatment, the sooner your depression will lift. There are no physical tests for
depression, though your doctor may examine you and do some urine or blood tests to rule out other
conditions that have similar symptoms, such as an underactive thyroid.
The main way in which your doctor will tell if you have depression is by asking you lots of questions about
your general health and how the way you are feeling is affecting you
mentally and physically.
Try to be as open as you can be with
the doctor. Describing your symptoms and how they are affecting you will really
help your doctor understand if you have depression and how severe it is. Any discussion you have with your doctor will be confidential. Your doctor will only ever break this rule if there's a
significant risk of harm to either yourself or others, and if informing a
family member or carer would reduce that risk.
Treating clinical depression
Treatment for depression usually
involves a combination of medicines, talking therapies and self-help.
Treatment options
The kind of treatment that your
doctor recommends will be based on the type of depression you have. Below
is a short description of the types of treatment your doctor may recommend.
Mild depression
- wait and see – if you're diagnosed with mild
depression, your depression may improve by itself. In this case,
you'll simply be seen again by your doctor after two weeks to monitor
your progress. This is known as watchful waiting.
- exercise – there is evidence that
exercise may help depression and it is one of the main treatments if
you have mild depression. Your doctor may refer you to a qualified fitness
trainer for an exercise scheme, or you can find out more about starting exercise here.
- self-help groups – talking through
your feelings can be helpful. You could talk either to a friend or
relative, or you can ask your doctor to suggest a local self-help group. Your doctor may also recommend self-help books and online cognitive
behavioural therapy (CBT).
Mild to moderate depression
- talking therapy – if you have mild depression that
isn't improving, or you have moderate depression, your doctor may recommend a
talking treatment (a type of psychotherapy). There are different types
of talking therapy for depression, including cognitive behavioural therapy (CBT) and counselling. Your doctor can refer you for
talking treatment or in some parts of the country you might be able to
refer yourself.
Moderate to severe depression
- antidepressants – antidepressants are tablets
that treat the symptoms of depression. There are almost 30 different kinds
of antidepressant. They have to be prescribed by a doctor,
usually for depression that is moderate or severe.
- combination therapy – your doctor may
recommend that you take a course of antidepressants plus talking
therapy, particularly if your depression is quite severe. A combination of
an antidepressant and CBT usually works better than having just one of
these treatments.
- mental health teams – if you have
severe depression, you may be referred to a mental health team made up of
psychologists, psychiatrists, specialist nurses and occupational
therapists. These teams often provide intensive specialist talking
treatments as well as prescribed medication.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) helps
you understand your thoughts and behaviour and how they affect you. CBT recognises that events in your
past may have shaped you, but it concentrates mostly on how you can change the
way you think, feel and behave in the present.
It teaches you how to
overcome negative thoughts, for example being able to challenge hopeless
feelings. CBT is available on the NHS for
people with depression or any other mental health problem that it has been
shown to help.
You normally have a short
course of sessions, usually six to eight sessions, over 10 to 12 weeks on
a one-to-one basis with a counsellor trained in CBT. In some cases, you may be
offered group CBT.
Online CBT
Computerised CBT is a form of CBT
that works through a computer screen, rather than face-to-face with a
therapist. It's delivered in a series of
weekly sessions and should be supported by a healthcare professional. For
instance, it's usually prescribed by your doctor and you may have to use the
surgery computer to access the programme.
Interpersonal therapy (IPT)
IPT focuses on your relationships
with other people and on problems you may be having in your relationships, such
as difficulties with communication or coping with bereavement. There's some evidence that IPT can be
as effective as antidepressants or CBT, but more research is needed.
Psychodynamic psychotherapy
In psychodynamic (psychoanalytic)
psychotherapy, a psychoanalytic therapist will encourage you to say whatever is
going through your mind. This will help you to become aware of
hidden meanings or patterns in what you do or say that may be contributing to
your problems.
Counselling
Counselling is a form of therapy that
helps you think about the problems you are experiencing in your life to find
new ways of dealing with them. Counsellors support you in finding solutions to
problems, but do not tell you what to do.
Counselling on the NHS usually consists
of six to 12 hour-long sessions. You talk in confidence to a
counsellor, who supports you and offers practical advice.
Counselling is ideal for people
who are basically healthy but need help coping with a current crisis, such as
anger, relationship issues, bereavement, redundancy, infertility or the onset
of a serious illness.
Getting help
Your first port of call should be
your doctors, who can refer you for NHS talking treatments for depression available
locally. In some parts of the country, you
also have the option of self-referral. This means that if
you prefer not to talk to your doctors, you can go directly to a
professional therapist.
Antidepressants are medicines that treat
the symptoms of depression. There are almost 30 different kinds available. Most people with moderate or severe
depression benefit from antidepressants, but not everybody does. You
may respond to one antidepressant but not to another, and
you may need to try two or more treatments before you find one
that works for you.
The different types of antidepressant
work about as well as each other. However, side effects vary between
different treatments and people. When you start taking
antidepressants, you should see your doctor or specialist nurse every week or two
for at least four weeks to see how well they are working. If they are
working, you'll need to continue taking them at the same dose for at least
four to six months after your symptoms have eased.
If you've had bouts of depression in
the past, you may need to continue to take antidepressants
for up to five years or longer. Antidepressants aren't addictive, but
you may get some withdrawal symptoms if you stop taking them suddenly or
you miss a dose.
Selective serotonin reuptake inhibitors (SSRIs)
If your doctor thinks you would benefit
from taking an antidepressant, you'll usually be prescribed a modern type
called a selective serotonin reuptake inhibitor (SSRI).
Examples of commonly used SSRI antidepressants are Seroxat (paroxetine), Prozac (fluoxetine) and Cipramil (citalopram).
They help increase the level of a
natural chemical in your brain called serotonin, which is thought to be a
"good mood" chemical. SSRIs work just as
well as older antidepressants and have fewer side effects.
They can, however, cause nausea and
headaches, as well as a dry mouth and problems having sex. However,
all these negative effects usually improve over time. Some SSRIs aren't suitable
for children under the age of 18. Research shows that the risk of self-harm and suicidal behaviour may
increase if they're taken by under-18s. Fluoxetine is the only SSRI that
can be prescribed for under-18s, and even then only when a specialist has
given the go-ahead.
Tricyclic antidepressants (TCAs)
This group of antidepressants is used
to treat moderate to severe depression. TCAs, which includes Imipramil (imipramine) and amitriptyline, have been around for
longer than SSRIs.
They work by raising the levels
of the chemicals serotonin and noradrenaline in your brain. These both help
lift your mood. They're generally quite safe, but
it's a bad idea to smoke cannabis if you are taking TCAs because it can
cause your heart to beat rapidly.
Side effects of TCAs may include
a dry mouth, blurred vision, constipation, problems passing urine, sweating,
light-headedness and excessive drowsiness, but vary from person to person. The side effects usually ease
after seven to 10 days, as your body gets used to the medication.
Other antidepressants
New antidepressants, such as Efexor (venlafaxine), Cymbalta or Yentreve (duloxetine) and Zispin Soltab (mirtazapine), work in
a slightly different way from SSRIs and TCAs.
Venlafaxine and duloxetine are
known as SNRIs (serotonin-noradrenaline reuptake inhibitors). Like
TCAs, they change the levels of serotonin and noradrenaline in your brain. Studies have shown that an SNRI can
be more effective than an SSRI, though they're not routinely prescribed
as they can lead to a rise in blood pressure.
Withdrawal symptoms
Antidepressants are not addictive in
the same way that illegal drugs and cigarettes are, but when you stop
taking them you may have some withdrawal symptoms, including:
- upset stomach
- flu-like symptoms
- anxiety
- dizziness
- vivid dreams at night
- sensations in the body that feel like electric
shocks.
In most cases these are quite mild
and last no longer than a week or two, but occasionally they can be quite
severe. They seem to be most likely to occur with paroxetine (Seroxat)
and venlafaxine (Efexor). Withdrawal symptoms occur very soon
after stopping the tablets, so can easily be told apart from symptoms of
depression relapse, which tend to occur after a few weeks.
Common questions about
antidepressants answered:
How long does it take for antidepressants to work?
You may need to take antidepressants for two to
four weeks before you notice any improvement in your symptoms. During this time, you may experience
side effects such as:
- anxiety and agitation
- drowsiness
- blurred vision
- nausea (feeling sick).
These side effects can be unpleasant
at first, but it's important to persist with treatment as your body will
usually get used to the medication over time.
How antidepressants work
Antidepressants work by increasing
the levels of chemicals in your brain called neurotransmitters. The levels of
neurotransmitters will rise gradually. This is why most people will need to
take antidepressants for a few weeks before they start to work.
It's important that you continue to
take your medicine at the prescribed dose to give it time to work properly. You
should take your antidepressants for at least four to six weeks to see if
they're effective. If they still aren't working after this time, your doctor may
consider changing to a different type.
Stopping antidepressants
You shouldn't stop taking
antidepressants suddenly, as this can cause withdrawal symptoms such as:
- flu-like symptoms
- dizziness
- vivid dreams
- sensations in your body that feel like electric shocks.
If you have been taking
antidepressants for at least four weeks and you have felt little or no benefit,
speak to your doctor. They may recommend increasing your dose or changing to a
different antidepressant. If you want to stop taking
antidepressants, your doctor will normally reduce your dose gradually over a
four-week period to reduce withdrawal symptoms.
Can I drink alcohol if I'm taking antidepressants?
Drinking alcohol while taking antidepressants is generally not advised
because alcohol can make depression worse and it can increase the side effects
of some antidepressants, such as drowsiness, dizziness and problems with
co-ordination.
Therefore, it’s generally safest to
avoid any alcohol if you are taking antidepressants, particularly if you are
going to drive or operate machinery.
See below for advice specific to the
different types of antidepressants that are available:
Selective serotonin re-uptake inhibitors (SSRIs) –
SSRIs are generally not known to cause any problems when taken with alcohol and
it may be safe to drink alcohol while taking them, although manufacturers of
these medications advise avoiding alcohol during treatment.
Tricyclic antidepressants (TCAs) – drinking alcohol while taking TCAs can make you feel drowsy and
affect your co-ordination, particularly during the first few weeks of
treatment; alcohol avoidance is advised by the manufactures of these
medications, although it may be safe to drink small amounts after a few weeks
once the side effects have settled
Monoamine-oxidase inhibitors (MAOIs) – a substance called tyramine, found in some alcoholic drinks
(such as wine, beer, sherry and lager), can cause serious side effects if taken
with MAOIs, such as a sudden and dangerous rise in blood pressure; if you’re
taking an MAOI, it’s best to not to drink alcohol and any food or drinks that
contain tyramine should be completely avoided
Other antidepressants – most other antidepressants are not known to cause problems when
taken with alcohol, although manufacturers generally advise drinking alcohol
with caution; you should avoid drinking alcohol if you are taking a medication
called mirtazapine because this can make you
feel very sleepy.
You should never stop taking any
antidepressant medication just so you can drink alcohol, as stopping
antidepressants suddenly can cause withdrawal effects such as flu-like
symptoms, sensations in the body that feel like electric shocks and seizures
(fits).
Finding out more about your medication
If you are not sure what type of
antidepressant you’re taking and don’t know whether you should avoid alcohol,
speak to your doctor or pharmacist. You can also call NHS 111 for advice.
It may help to check the patient
information leaflet (PIL) that comes with your medication to see whether
alcohol should be avoided.
How should antidepressants be stopped?
You should always talk to your doctor,
prescriber or pharmacist if you are thinking of stopping your antidepressants. A dose of antidepressants should
be slowly reduced over one to two weeks if treatment has lasted less than eight
weeks, and over six to eight weeks if treatment has lasted six to eight
months.
This is because although
antidepressants are not classed as addictive medicines, they can cause serious
withdrawal symptoms if stopped abruptly. These symptoms may be entirely new or
similar to some of the original symptoms of the illness.
Withdrawal symptoms
Withdrawal symptoms depend on the
type of antidepressant. For example:
- selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs) and venlafaxine commonly cause a flu-like illness (chills, muscle pain, excessive sweating, nausea and headache) and insomnia.
- SSRIs and venlafaxine can also cause dizziness or electric shock sensations.
- monoamine oxidase inhibitors (MAOIs) can cause symptoms such as irritability, agitation, sleep problems and movement disorders.
The onset of withdrawal symptoms is
usually within five days of stopping the medicine and will generally last for
up to six weeks. If symptoms are severe, alternative approaches may have to be used,
such as reintroducing another antidepressant from the same group and reducing
the dose more slowly, or stopping completely and managing your symptoms.
Talk to your doctor or prescriber to
agree the best approach for you. The Royal College of Psychiatrists
has suggested a number of things you can do before, during and after you have
stopped taking antidepressants to help you through the process.
Taking antidepressants
Stay in touch with your doctor or
specialist nurse when you start taking antidepressants. You should continue
taking the antidepressants for at least four weeks (six weeks if you are
elderly) to see how well they are working.
If your antidepressants are working,
treatment should be continued at the same dose for at least six months to a
year. If you have a repeated history of depression, you should continue to receive
maintenance treatment for up to five years, or possibly even longer.
If you have any concerns about this
information, or need any help understanding it and relating it to your own
situation, you should talk to your doctor or pharmacist (chemist).
Other Treatments
St John's wort
St John's wort is a herbal treatment
that some people take for depression. It's available from health food shops and
pharmacies. There's some evidence that it may
help mild to moderate depression, but it's not recommended by
doctors. This is because the amount of active ingredients varies among
individual brands and batches, so you can never be sure what
sort of effect it will have on you.
Taking St John's wort with other
medications, such as anticonvulsants, anticoagulants, antidepressants and the contraceptive pill, can also cause serious
problems. You shouldn't take St John's
wort if you are pregnant or breastfeeding, as we don't know for sure that it's
safe. Also, St John's wort can interact with
the contraceptive pill, reducing its contraceptive effect.
Electric shock treatment
Sometimes electroconvulsive therapy
(ECT) may be recommended if you have severe depression and other treatments,
including antidepressants, haven't worked. During ECT, you'll first be given an
anaesthetic and medication to relax your muscles. Then you'll receive an
electrical "shock" to your brain through electrodes placed on your
head.
You may be given a series of ECT
sessions. It is usually given twice a week for three to six weeks. For most people, ECT is good
for relieving severe depression, but the beneficial effect tends to
wear off after several months. Some people get unpleasant side
effects, including short-term headaches, memory problems, nausea and muscle
aches.
Lithium
If you've tried several different
antidepressants and had no improvement, your doctor may offer you a type of
medication called lithium in addition to your current treatment. There are two types of lithium: lithium carbonate and lithium citrate. Both are usually effective,
but if you are taking one that works for you, it's best not to change.
If the level of lithium in your blood
becomes too high, it can become toxic. You will therefore need blood tests
every three months to check your lithium levels while you're on the medication. You'll also need to avoid eating
a low-salt diet because this can also cause the lithium to become
toxic. Ask your family doctor for advice about your diet.
Living with clinical depression
There are some key steps
you can take to lift your mood and help your recovery from depression.
Take your medication
It is important to take your
medication as prescribed, even if you start to feel better. If you stop your
medication too soon, you could have a relapse of your
depression. If you have any questions or concerns about the medication you're
taking, talk to your doctor or pharmacist.
It may help to read the
information leaflet that comes with your medication to find out
about possible interactions with other drugs or supplements. Check with
your doctor first if you plan to take any over-the-counter remedies such
as painkillers, or any nutritional supplements. These can sometimes interfere
with antidepressants.
Exercise and diet
Exercise and a healthy diet can make
a tremendous difference to how quickly you recover from depression. And they
will both improve your general health, too. Research suggests that exercise may
be as effective as antidepressants at reducing depression
symptoms.
Being physically active can lift your
mood, reduce stress and anxiety, boost the release of endorphins (your body's
feel-good chemicals) and improve self-esteem. Also, exercising may be a good
distraction from negative thoughts, and it can improve social interaction.
It also helps your mood to
have a healthy diet. In fact, eating healthily seems to be just as
important for maintaining your mental health as it is for
preventing physical health problems.
Mindfulness
It can be easy to rush through life
without stopping to notice much. Paying more attention to the present moment –
to your own thoughts and feelings, and to the world around you – can improve
your mental wellbeing. Some people call this awareness 'mindfulness', and you
can take steps to develop it in your own life.
The National Institute for Health and
Clinical Excellence (NICE) recommends 'mindfulness based cognitive therapy' for
people who are currently well but have experienced three or more previous
episodes of depression. It may help to prevent a future episode of depression.
Talking
about it
Sharing
a problem with someone else or with a group can give you support and
an insight into your own depression. Research shows that talking can help
people recover from depression and cope better with stress.
You
may not feel comfortable about discussing your mental health and sharing your
distress with others. If so, writing about how you feel or expressing your
emotions through poetry or art are other ways to help your mood.
Smoking, alcohol and Drugs
It may be tempting to smoke or drink
to make you feel better. Cigarettes and booze may seem to help
at first, but they make things worse in the long run. Be extra cautious with
cannabis. You might see it as harmless, but research has revealed a
strong link between cannabis use and mental illness, including depression.
The evidence shows that if you smoke
cannabis you:
- make your depression symptoms worse
- feel more tired and uninterested in things
- are more likely to have depression that
relapses earlier and more frequently
- will not have as good a response to
antidepressant medicines
- are more likely to stop using
antidepressant medicines
- are less likely to recover fully.
If you drink or smoke too
much or use drugs, get advice and support from your doctor, or read these
articles about getting help if you want to stop smoking, taking drugs or drinking too much alcohol.
Work and Finances
If your depression is caused by
working too much or is affecting your ability to do your job, you may need time
off to recover. However, there is evidence that taking prolonged time off work
can make depression worse. There's also quite a lot of evidence that going
back to work can help you recover from depression.
It's important to avoid too much
stress, and this includes work-related stress. If you're employed, you may be
able to work shorter hours or work in a more flexible way, particularly if job
pressures seem to trigger your symptoms. Under the Equality Act (2010) all employers must
make reasonable adjustments to make the employment of people with disabilities
possible. This can include people with a diagnosis of mental illness.
If you can't work as a result of
your depression, you may be eligible for a range of benefits, depending on
your circumstances. These include:
- Statutory
sick pay
- Incapacity Benefit
- Disability Living Allowance
- Attendance
Allowance
- Carer's Allowance
- Council
Tax Benefit
- Housing Benefit.
Looking after someone with depression
It's
not just the person with depression who is affected by their illness.
The people close to them are too. If
you're caring for someone with depression, your relationship with them and
family life in general can become strained. You may feel at a loss as to
what to do. Finding a support group and talking to others in a similar
situation might help.
If
you're having relationship or marriage difficulties, it might help to contact a
relationship counsellor who can talk things through with you and your partner. Men
are less likely to ask for help than women and are also more likely
to turn to alcohol or drugs when depressed.
Coping with bereavement
Losing
someone close to you can be a trigger for your depression. When
someone you love dies, the emotional blow can be so powerful that you
feel it's impossible to ever recover. However, with time and the right help and
support, it is possible to start living your life again.
Depression and suicide
The majority of suicide cases are linked with mental
disorders, and most of them are triggered by severe depression. Warning signs that someone with
depression may be considering suicide are:
- making final arrangements, such as giving away
possessions, making a will or saying goodbye to friends
- talking about death or suicide – this may
be a direct statement, such as "I wish I was dead", but often
depressed people will talk about the subject indirectly, using phrases
like "I think dead people must be happier than us" or "Wouldn't
it be nice to go to sleep and never wake up"
- self-harm, such as cutting their arms or
legs, or burning themselves with cigarettes
- a sudden lifting of mood, which could
mean that a person has decided to commit suicide and feels better because
of this decision.
If you are feeling suicidal or
are in the crisis of depression, contact your doctor as soon as possible. They
will be able to help you. If you can't or don't want to contact
your family doctor, you can call the Samaritans on 08457 90 90 90, 24 hours a day, seven days a
week.
Helping a suicidal friend or relative
If you see any of the above warning
signs:
- get professional help for the person
- let them know they are not alone and
that you care about them
- offer your support in finding other solutions
to their problems.
If you feel there is an immediate
danger, stay with the person or have someone else stay with them, and remove
all available means of committing suicide, such as medication.
Over-the-counter drugs such as painkillers can be just as dangerous as
prescription medication. Also, remove sharp objects and poisonous household
chemicals such as bleach.
Psychotic depression
Psychotic depression
Some people who have severe clinical
depression will also experience hallucinations and delusional thinking, the
symptoms of psychosis. Depression with psychosis is known as psychotic
depression.
What are the symptoms of severe
depression?
Having severe clinical depression
means feeling sad and hopeless for most of the day, practically every day, and
having no interest in anything. Getting through the day feels almost
impossible. Other typical symptoms of severe
depression are:
- fatigue (exhaustion)
- loss of pleasure in things
- disturbed sleep
- changes in appetite
- feeling worthless and guilty
- being unable to concentrate or being indecisive
- thoughts of death or suicide.
What are the symptoms of psychosis?
Having moments of psychosis
(psychotic episodes) means experiencing:
- delusions – thoughts or beliefs that are unlikely to
be true
- hallucinations – when a person
hears (and in some cases feels, smells, sees or tastes) things that aren't
there; a common hallucination is hearing voices.
The delusions and hallucinations
almost always reflect the person's deeply depressed mood – for example, they
may become convinced they're to blame for something, or that they've committed
a crime.
"Psychomotor agitation" is
also common – this means not being able to relax or sit still, and constantly
fidgeting. Or, at the other extreme, a person
with psychotic depression may have "psychomotor retardation", where
both their thoughts and physical movements slow down.
People with psychotic depression are
at greater risk than normal of thinking about suicide.
What's the cause?
The cause of psychotic depression is
not fully understood. What we do know is that there's no single cause of
depression and it has many different triggers. For some, stressful life events such
as bereavement, divorce, serious illness or financial worries can be the cause.
Genes probably play a part, as severe
depression can run in families, although it's not known why some people
also develop psychosis. Many people with psychotic depression
will have experienced adversity in childhood, such as a traumatic event.
How is it treated?
Treatment for psychotic depression
involves:
- medication – a combination of antipsychotics and antidepressants can help relieve the symptoms of psychosis
- psychological therapies – the one-to-one talking
therapy cognitive behavioural therapy (CBT) has
proved successful in helping some people with psychosis
- social support – support with social needs, such as education, employment or
accommodation.
The patient may need to stay in
hospital for a short period while they're receiving this treatment. Sometimes electroconvulsive therapy
(ECT) may be recommended if the patient has severe depression and other
treatments, including antidepressants, haven't worked.
Treatment is usually very effective,
although patients may need to be continuously monitored in follow-up
appointments.
Getting help for others
People with psychosis are often
unaware that they're thinking and acting strangely. Because of this lack of insight, it's
often down to the friends, relatives or carers of a person affected by
psychosis to seek help for them.
If you are concerned about someone you
know and think they may have psychosis, you could contact their social worker
or community mental health nurse if they've previously been diagnosed with a
mental health condition. If this is the first time they've
shown symptoms, contact their doctor or take them to A&E.
If you think the person’s symptoms
are placing them at possible risk of harm you can:
- take them to the nearest accident and emergency (A&E) department,
if they agree
- call their family doctor or their local out-of-hours on call doctor
- call 999 and ask for an ambulance.
Driving
Having psychosis could affect your ability
to drive. If you have been diagnosed with
psychotic depression, it's your legal obligation to tell the Driver and Vehicle
Licensing Agency (DVLA) as it could affect your driving ability.
Source: NHS Choices.
Source: NHS Choices.